Cervical Smear (Pap Smear)

Cervical cancer is a type of cancer that starts in the place called the transformation zone where the tissue lining the surface of the vagina and the tissue lining the inner surface of the cervix intersect. While the epithelial cells lining the inner surface of the cervix have glandular (secretory) properties, the cells of the vagina are squamous (squamous epithelium) cells that are responsible for protecting the tissue from external factors. The reason why it is called the transformation zone is that these two different cell types are in the neighborhood and are always “incompatible” with each other due to their different structures.

In the exchange zone, both types of cells are trying to expand their borders, and therefore they are almost at war in this intersection zone. There is a constant destruction and renewal in the region. During this time, some cells are constantly discarded and replaced with new ones. Here, pap smear examination is the examination of the cells in the region during the examination under the microscope. Since cervical cancer often starts from the transformation zone, examining the cells collected from this region with a microscope gives us valuable information. By looking at the structural features of the cells which are collected here, under the microscope, it can be determined whether the cells are in the normal regeneration process, whether the cells have a tendency to become cancerous, and in advanced cases, the cancerous cells themselves can be observed.

When changes in the direction of malignancy begin in the cells in the transformation zone of the cervix, this manifests itself as an “atypical appearance” under the microscope. Although the definition of atypical describes that unusual cells are seen here, not every atypical appearance shows the tendency to become cancerous. When atypical cells are observed, either the pap smear is repeated after drug therapy, or further examination is performed by taking a biopsy, as will be explained below, according to the pathologist’s recommendation.

Cervical cancer is a disease with a long “incubation period”. The time from the onset of atypicalization in cells, that is, deformities, to the formation of cancer is 5-10 years. It is a type of cancer that has a low chance of being cured when it is in advanced stages, and a very high chance of being cured if it is caught in the early stages (before it starts). This shows how important early diagnosis is in terms of treatment.

Papsmear is a cancer screening test that has been used since 1941 and is the most effective of all cancer early detection methods developed to date. Since it has been used in the USA, there has been a 70% decrease in death from cervical cancer so far. Unfortunately, despite such an effective method, most of our women in our country do not know or ignore this method. Questionnaires of women with cervical cancer reveal that this test has never been performed or is not performed regularly in more than 80% of women.

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